From the January Issue of JAMDA

Abstract

Elderly people with hip fractures had less chance of dying, being admitted to a nursing home, and becoming dependent in activities of daily living if they went through a 12-month intensive plan that included strength training and interventions to reduce frailty. The 124 community-dwelling participants in the controlled trial were recruited during treatment at an outpatient clinic. Participants were randomized to usual care or an intervention (called HIPFIT) that included weight lifting and treatment as needed for balance problems, osteoporosis, poor vision, depression, vitamin D deficiency, and poor cognition. The intervention included a review of home safety, social support, the use of hip protectors, and medications. The participants in the intervention group had 81% less risk of death than did controls. Nursing home admissions were 84% less in the intervention group, which also had less need for assistive devices and less difficulty with activities of daily living. The study was limited in part by the small sample size, but the results suggest that HIPFIT can improve care if applied diligently during the year after a hip fracture, the researchers said. “We have shown for the first time that provision of 12 months of supervised, high-intensity progressive resistance training, with simultaneous targeting and treatment of other deficits related to frailty in a typical hip fracture cohort, is feasible and effective,” they wrote. “Lowering the burden of excess morbidity and mortality after hip fracture requires treatment of the underlying frailty itself, not just the broken bone,” they added. ▸ Source: Effects of High-Intensity Progressive Resistance Training and Targeted Multidisciplinary Treatment of Frailty on Mortality and Nursing Home Admissions After Hip Fracture: A Randomized Controlled Trial – Singh et al. The Simplified Nutritional Appetite Questionnaire (SNAQ) was less effective than the Mini-Nutritional Assessment (MNA) in predicting malnutrition in older adults, but it may be useful predicting weight loss, a cross-sectional study of 175 adults aged 65 years and older revealed. The study population included community-dwelling seniors, hospital patients, and nursing home residents. The researchers compared the effectiveness of the SNAQ with that of the MNA. Using a SNAQ score of less that 14 to define a person as at risk for malnutrition or malnourishment produced an incorrect nutrition status 27% of the time. Sensitivity of the SNAQ questionnaire was 71%, and the specificity of the questionnaire was 74%. By contrast, using an MNA score of less than 11 to predict malnutrition or malnourishment yielded a sensitivity and specificity of 98% and 100%, respectively. However, the MNA is not widely used in clinical practice because it is time consuming and it is not a self-assessment tool, the researchers said. The findings suggest that the SNAQ is not useful as a screening tool for malnutrition, the researchers wrote. However, they added that the test “may be relevant in practice as a first assessment step because its practical characteristics support its use” and “it might predict weight loss earlier than the MNA.” ▸ Source: Screening Older People at Risk of Malnutrition or Malnourished Using the Simplified Nutritional Appetite Questionnaire (SNAQ): A Comparison With the Mini-Nutritional Assessment Tool – Rolland et al. The prevalence of antidepressant prescribing in adults aged 65–104 years was 10% for community-dwelling residents and 38% for nursing home residents, in a study of 326 family practices in England and Wales. The researchers reviewed 2008–2009 data from The Health Improvement Network, a national database. The study population included 10,387 nursing home residents and 403,259 community-dwelling adults. In both nursing home and community settings, antidepressant prescribing was more common for women than men. Of note, 28% of community dwellers and 43% of nursing home residents had no recorded indication for an antidepressant. The findings suggest that more attention to antidepressant prescribing is needed because of potential side effects and interactions, the researchers said. ▸ Source: Antidepressant Prescribing in Older Primary Care Patients in Community and Care Home Settings in England and Wales – Harris et al.